Schmorl's nodes

Schmorl's nodes were first described by the pathologist Christian Georg Schmorl in 1927 as a herniation of the nucleus pulposus through the cartilaginous and bony endplate into the vertebral body. Although such lesions present most commonly as incidental findings in asymptomatic patients (or in patients with back or radicular pain due to other etiology), there have been several reports emphasizing the deleterious effects of the inflammatory response and endplate changes elicited by the herniation of for such reasons, Schmorl's nodes have been occasionally implicated in the etiology of chronic axial pain as well as in pathological osteoporotic fractures 1).

The protrusions may contact the marrow of the vertebra, leading to inflammation.

They may or may not be symptomatic, and their etiological significance for back pain is controversial. Schmörl nodes are found in 40-75% of autopsies.

Schmörl nodes are among the diagnostic criteria of Scheuermann disease

A limbus vertebra is closely related to a Schmörl node as well.

It is believed that Schmörl nodes develop following back trauma, although this is incompletely understood. A more recent study suggests nucleus pulposus pressure on the weakest part of the endplate or vertebral development process during early life as possible explanation 7.

In the acute stage, Schmörl nodes can be difficult to diagnose or detect due to sclerosis around the margin of the herniation not having had time to develop.

Usually, they are small nodular lucent lesions involving the inferior endplate of lower thoracic and lumbar vertebral bodies. However, the involvement of both the inferior and the superior endplates is not uncommon. A sclerotic margin may be present.

They are better identified on CT images, showing the same pattern observed on radiographs.

Schmörl nodes are best seen on the sagittal sequences and usually exhibit the same signal characteristics as the adjacent disc.

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